# Fluid calculation

balance in fluid =input-output

input example :iv fluid ,oral or nasogastric intake ,iv medication
don't forget to consider amount of fluid used to reconstitute medication in calc *
balance
output example : urine , sweeting ,berthing , lachrymation *
normal balance should be zero but we accept 1000cc
example of positive and negative balance
? how to calculate maintenance fluid(total daily requirement over 24h)
: method #1
maintenance fluid=35cc/KG/Day (over 24h)
: method #2
we can use it in adult and pediatric
the first 20 kg give 1500 cc then any KG multiple it by 20cc

: type of fluid
crystalloid fluid like normal saline , Lactated Ringer's ,dextrose-1
source of enrage ,contain minerals like ca :(Lactated Ringers, dextrose ) *
normal saline : zero enrage
type of normal saline(different osmolarity) : 1- hypotonic 0.45% nacl 2- isotonic
0.9% nacl 3- hypertonic saline 3%
* glucose : glucose 5% , glucose 4.3

calloid : albumin , Hetastarch ,dextran , gelatin-2

crystalloid :cheaper ,more easier to administration ,more Compatible with

medication ,lower s/e like allergic reaction(serum sickens) ,bleeding ,infection
,kidney injury
disadvantage: increase risk to developed Hyperchloremic acidosis(non anion gap
metabolic acidosis) when we give more than 3L of crystalloid

colloid:more viscous so we need less volume,, so its favorite for HF pt .(have

higher retention site

normal osmolarity in blood : range of 285 to 310 mosmoles/liter

always we should calc osmolarity in blood in pt have DKA (hyperglycemia
increase osmolarty ) ,pt with change in sodium ,pt with change blood urea
nitrogen
osmolarity in blood= 2 X Na + Glucose + Urea ( all in mmol/L)
OR= 2* Na + [Glucose]/18 + [ BUN ]/2.4 where [Glucose] and [BUN] are measured in mg/dl

fluid osmolarty = % X 106 X (equivalent /M.W)

example :normal sline 0.45%
x106x(2/58.44)=154 mosmoles/liter (hypo)(0.45/100)

if pt osmolarity in blood hypo give hypo fluid if hyper give hyper if normal range *
give iso fluid
example #2 :glucose saline 0.18 (in this case we calc osmolarity for glu and
saline separately b3den mnjm3ahom lab3d)

hypernatremia hyponatremia calculator

Na normal level is 135-145 so hyponatremia less than 135

:we should know the type of hyponatremia *
:hypotonic hyponatremia-1
a- euvolemic : (SIADH) syndrome of inappropriate secretion of antidiuretic
hormone
b- hypovolemic :diuretic use
c- hypervolemia (dilutional hyponatremia): volume over load like HF, nephrotic
syndrome liver crosi
isotonic hyponatremia : hyperlipidemia or hyperproteinemia> increase -2
extracellular volume
hypertonic hyponatremia: like in case elevated glucose: glucose increase -3
osmalirty and work as osmotic diuretic

management of hyponatremia
in general we give normal saline
sodium daily 1-2meq /kg (1)
sodum deficit =total body water(TBW) x (sodium Desired-serium sodium=12)
total body water(TBW)= pt Weight x 0,6 for male and 0,5 for female

in acute sodium deficit the correction should not be exceed 8-12meq daily
(increase or decrase) cuz risk of Osmotic demyelination syndrome

total Na requirement = sodium daily(1/kg) + sodum deficit(TBWx12meq)

we give it as 0,45 nacl in dka pt cuz they are dehydration > 0.9nacl or 3% in
.case HF and
each letter of 0,45% contain 77na
each letter of 0,9% contain 154na
each letter of 3% contain 513na

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